University Children's Hospital, Munich, Germany.
University Children's Hospital, Munich, Germany.
Ann Allergy Asthma Immunol. 2014 Feb;112(2):132-139.e1. doi: 10.1016/j.anai.2013.11.019. Epub 2013 Dec 17.
In most children with asthma and atopy, onset of disease occurs early in life, indicating a crucial role of in utero and early childhood environment. However, only a small part of this burden of disease established early in life has been explained.
To examine the effects of early environmental exposures on the development of asthma and atopy within the setting of an affluent urban population.
The authors followed 526 German children from birth to 5 years of age. Parental interviews in pregnancy and then yearly assessed the health of the child and environmental characteristics. Endotoxin and allergens in house dust were measured at 3 months. Atopic sensitization was assessed at 1 and 5 years.
In atopic mothers, acute atopic symptoms during pregnancy were associated with increased risk of early atopic dermatitis (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI] 1.00-3.02) and allergic rhinitis at 5 years (aOR 2.11, 95% CI 1.01-4.41). Further, maternal illnesses during pregnancy (ie, repeated common colds) increased the risk of asthma at 5 years (aOR 2.31, 95% CI 1.12-4.78). Endotoxin in the child's mattress was inversely associated with atopic sensitization (aOR 0.79, 95% CI 0.64-0.97) and asthma (aOR 0.71, 95% CI 0.55-0.93). A contrasting effect of early endotoxin and mite exposure was observed for mite sensitization: mite exposure increased the risk of mite sensitization at 5 years (aOR 1.30, 95% CI 1.11-1.53), whereas endotoxin exposure was inversely associated with mite sensitization (aOR 0.73, 95% CI 0.57-0.95).
Factors affecting the in utero environment, such as maternal atopy and infections, and bacterial exposure in pregnancy or early life may act as immunomodulators enhancing or inhibiting the development of asthma and atopy in childhood.
在大多数患有哮喘和过敏症的儿童中，疾病的发病年龄较早，这表明子宫内和儿童早期的环境起着至关重要的作用。然而，在生命早期就已确定的这种疾病负担中，只有一小部分得到了说明。
在富裕的城市人群中，研究早期环境暴露对哮喘和过敏症发展的影响。
作者对 526 名德国儿童从出生到 5 岁进行了随访。在妊娠期间以及随后的每年，通过父母访谈评估儿童的健康状况和环境特征。在 3 个月时测量室内灰尘中的内毒素和过敏原。在 1 岁和 5 岁时评估过敏敏感情况。
在过敏症母亲中，妊娠期间急性过敏症状与早发性特应性皮炎（调整后的优势比[aOR] 1.74，95%置信区间[CI] 1.00-3.02）和 5 岁时过敏性鼻炎（aOR 2.11，95% CI 1.01-4.41）的风险增加有关。此外，妊娠期间母亲患病（即反复普通感冒）会增加 5 岁时哮喘的风险（aOR 2.31，95% CI 1.12-4.78）。儿童床垫中的内毒素与过敏敏感呈负相关（aOR 0.79，95% CI 0.64-0.97）和哮喘（aOR 0.71，95% CI 0.55-0.93）。对于螨过敏，早期内毒素和尘螨暴露的作用相反：螨暴露会增加 5 岁时螨过敏的风险（aOR 1.30，95% CI 1.11-1.53），而内毒素暴露与螨过敏呈负相关（aOR 0.73，95% CI 0.57-0.95）。
影响子宫内环境的因素，例如母亲过敏症和感染，以及妊娠或儿童早期的细菌暴露，可能作为免疫调节剂，增强或抑制儿童期哮喘和过敏症的发展。
